For family of dementia patients, adult day care can help

NEW YORK (Reuters Health) - Regularly using adult day care
services for a family member with dementia may help reduce
stress for caregivers, a new study suggests.

"Caring for someone with dementia often involves high levels
of daily stress," Steven H. Zarit said. "This amount of stress
exerts wear-and-tear on the body."

Zarit led the new study at The Pennsylvania State University
in University Park.

Some researchers have thought that adult day care may
actually increase stress, because of the extra effort of getting
the person ready to go in the morning and transitioning back in
the evening. But based on this and a previous study, that
doesn't seem to be true, Zarit said.

"What we found is that each day a caregiver uses adult day
care interrupts a part of the body's stress response, and leads
to a more normal level of a key stress hormone, DHEA-S," he
said.

DHEA-S, short for dehydroepiandrosterone-sulfate, is
produced by the adrenal glands. Some studies have shown that
high levels of this hormone can help protect the body against
the damaging effects of stress.

But prolonged exposure to stress can deplete DHEA-S levels,
the authors write in The American Journal of Geriatric
Psychiatry.

Their study included 151 people caring for a family member
with dementia who used an adult day care service at least twice
a week. The caregivers were an average of 62 years old, and
their family members with dementia were an average of 82.

For eight days, caregivers reported their stressors and mood
levels by phone once daily and collected their own saliva
samples to be tested for DHEA-S five times per day.

The researchers found that caregiver DHEA-S levels were
higher on the day following an adult day care day, suggesting
that a break from caring for their family member allowed their
body to restore this hormone level.

Caregivers who used the day care service more often tended
to have higher average mood scores for the eight days than those
who used it less frequently. Their mood levels tended to mirror
their DHEA-S hormone levels, with better mood on days with
higher DHEA-S scores, but there was no connection to symptoms of
depression.

"For years researchers have amassed a large literature on
the emotional stress and strain of caregiving," Susan T.
Charles, who was not involved in the new study, told Reuters
Health in an email.

Charles studies emotional processes across the adult life
span at the University of California, Irvine.

This study offers a solution on how to lessen the effects of
stress, she said.

"Given the rise in the number of people caregiving for a
family member with dementia as our population ages, this issue
is becoming more central to our public health," Charles said.

"Stress related to managing a relative's challenging
behaviors, helping a relative complete daily tasks or assisting
them with their medications can lead to stress that spills over
to other parts of a caregiver's life such as family conflict and
disruption, lost wages due to fluctuations in employment and
difficulty in maintaining important friendships outside of the
caregiving situation," said Joseph E. Gaugler. He researches
community-based services for caregiving families at the
University of Minnesota School of Nursing in Minneapolis and was
not involved in the new research.

"This accumulation of care-related and life-related stress
can then lead to negative mental or physical health outcomes on
the part of family caregivers, including depression, impaired
health or immune system response or even mortality," Gaugler
said.

Many family caregivers either do not know of adult day care
services, or think that the services are only "babysitting" and
do not take advantage of them, he said. But a good program
includes therapeutic activities that can help people with
chronic illnesses like Alzheimer's disease maintain function at
a higher level, Zarit said.

"Activities such as exercise, cognitive stimulation and
social programs can be very helpful for maintaining functioning,
and can be carried out in a respectful way," he said.

Area Agencies on Aging can be found throughout the country
and maintain a list of community resources. That would be a good
place for caregivers to start looking for information on adult
day care programs, Zarit said.

Gaugler recommends the National Adult Day Services
Association homepage (http://nadsa.org), which has a "find a
center new you" search tool, and the eldercare locator at
http://eldercare.gov.

SOURCE: http://bit.ly/1iDC0fP The American Journal of
Geriatric Psychiatry, online February 3, 2014.